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Has nine years of patient feedback helped improve their experience? – part 1 of 2

The NHS adult inpatient survey, developed by Picker, is one of the largest and longest running collections of patient experience information anywhere in the world. Each year, 1,250 people recently treated by each of England’s 151 NHS hospital providers are invited to share their experiences of the care they received. With the 2018 survey due for publication this week, Tiffany Gooden looks back at evidence on person centred care from the last nine years of the survey. This is part one of a two-part blog and covers four of the eight Picker principles of person centred care.

Emotional support, empathy and respect
Treating patients with respect and empathy is crucial for person centred care. Patients’ experiences of this improved over the last nine years, as described below. However, there were still far too many patients not receiving basic decency from hospital staff as of 2017. Yet, this is a time when dignity and kindness may be needed the most.

A greater proportion of patients said that doctors did not talk in front of them as if they weren’t there in 2017 (77%) versus 2009 (71%). Seventy-seven percent said the same thing about nurses in 2009 versus 83% in 2017. The proportion of patients that said they were ‘always’ treated with respect and dignity while in hospital also rose from 78% in 2009 to 82% in 2017. However, this still means that one in six patients felt that they weren’t always treated with respect.

Unfortunately, a low proportion of patients ‘definitely’ found someone on the hospital staff to talk to about their worries and fears over the nine year period (39% average). Also consistent was the inadequate proportion of patients that stated they always felt they were given enough emotional support from hospital staff during their stay (55% average from 2011 to 2017).

Respecting a patient’s privacy, especially at a time of vulnerability, is something all hospital staff should strive to do. The proportion of patients who were ‘always’ given enough privacy when being examined or treated on the ward increased from 87% in 2009 to 90% in 2017. Also on the rise, was the proportion who said they had privacy when discussing their condition or treatment (from 69% to 75%). Disappointingly, an upward trend in patients saying they ‘definitely’ received enough privacy while being examined or treated in the A&E department ended in 2015 at a high of 78%, dropping to an average of 77% that said this between 2015 and 2017.

Continuity of care and smooth transitions
Patients tell us they want joined-up care with smooth transitions between professionals and services. For people treated in hospital, the process of planning for and being discharged is important – but there has been little evidence of improvement. From 2012 to 2017, an average of 54% of patients consistently stated that they had ‘definitely’ been given enough notice about when they were going to be discharged. A little over half of patients (58% average) consistently stated that their discharge had not been delayed by the hospital. Those that said the delay was only up to an hour long was historically low and yet appeared to be on a declining trajectory from 16% in 2009 to 12% in 2017. The main reason for a delay has been due to the patient waiting for medicines (71% average).

Delaying discharge puts patients at a much higher risk of ill health. It also has a knock on effect, as patients unnecessarily take up beds. The government is fully aware of the issue, as mentioned in key policy documents, though we have yet to see any actual change occur.

With a more ageing population and more people living with long-term conditions and comorbidities, it is vital to ensure health and social care services are offered to all. However, since 2012, 82% of patients on average stated that hospital staff discussed with them whether they would need further health and social care services after leaving hospital – no improvement over the nine years. Until 2014, the proportion of patients was increasing that stated they were told who to contact if they were worried about their condition or treatment after discharge. This dropped from 77% in 2014 to 76% in 2015 and has remained consistent as of 2017. This means 1 in 4 people do not know who to contact after leaving hospital. Post-discharge support could have a huge impact on reducing readmissions which is better for the patient, clinical staff and the health system as a whole.

Fast access to reliable healthcare advice
Fast access is imperative for more effective treatment, shorter recovery time, a reduction in health risks and an overall better patient experience. Though, from admission to discharge, waiting times continue to be a concern. The proportion of patients (80% average) that said their admission date had not been changed by the hospital was consistent, with the exception of a slight peak to 81% in 2013. An average of 75% of patients said they were admitted as soon as they thought was necessary – 9% of patients have stated they should have been admitted a lot sooner over the years. Once admitted, an average of 64% said they did not have to wait long to get a bed on the ward. This leaves a disapprovingly high proportion of patients (34%) ‘definitely’ or ‘to some extent’ waiting too long for a bed.

The NHS Constitution pledges to provide care within specified waiting times. Unfortunately, these results showcase that in the last nine years, too many patients are not getting the care they need, when they need it. As a topic in the 2017 policy document, Next Steps on the NHS Five Year Forward Plan, it is expected that a more positive trend will appear in this area over the upcoming years.

Involvement in decisions and respect for patient’s preferences
Involvement in decisions have consistently been mediocre, with 53% of patients on average saying they were ‘definitely’ involved in decisions about their discharge from hospital. Further to this, the proportion of patients that stated they were ‘definitely’ involved as much as they wanted to be in decisions about their care and treatment was on an upward trend until 2015 (from 51% to 57%) but then went down to an average of 55% between 2016 and 2017.

Patient’s feedback should be consistently sought on a local level to better understand people’s preferences and experiences. There has been a strong positive trend of patients that stated they were asked to give their views on the quality of their care during their hospital stay; however the 2017 findings demonstrated that improvement is still very much needed – 10% in 2009 increased to 20% in 2017. This remains very low considering that all patients should be given the opportunity to offer feedback via the Friends and Family Test: this suggests that either patients are not being given this opportunity, or do not see it as offering feedback about quality.

How have patients’ experiences of information, communication and the physical environment and effective treatment from trusted professionals changed from 2009 to 2017? The second part of this blog, to be published tomorrow, investigates these questions.

Tags: Inpatient Survey, Inpatients Survey, NHS, patient experience, Person centred care.

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